The overall purpose of the MDS/Care Plan Coordinator is to manage the integrity of the Facility Medicare/Medicaid Programs. This includes, but is not limited to: verification of eligibility, entitlement and coverage; completion of MDS/PPS and OBRA assessments; accurate and timely submission of all supporting documentation, as well as submission of reports timely to corporate for billing. ESSENTIAL JOB FUNCTIONS include the following. Other duties may be assigned.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. • Conducts pre-admission nursing screenings as assigned; ensures Medicare Part A eligibility, entitlement and coverage criteria on all new facility admissions • Obtains Medicare qualifying diagnosis for residents obtaining Medicare A services and updates diagnosis for each change in diagnosis • Prepares, coordinates and maintains schedule of MDS and resident care plans for timely completion o Initiates interim care plan on all admissions/readmissions o Monitors residents for change in condition through facility meetings and ongoing interaction with staff regarding resident’s status o Ensures that resident care plans are updated as needed or indicated • Coordinates weekly Medicare meetings for interdisciplinary team and family care plan conferences • Assures preparation of Medicare denial letters for each resident discharged from Medicare coverage within time limits imposed by Medicare guidelines • Coordinates the distribution of care plan conference invitations to residents and families • Ensures electronic submission of MDS materials to the state regulatory agencies as directed • Utilizes the web based electronic computer programs to monitor the Medicare/Medicaid programs within the facility • Conducts in-service education programs regarding the MDS/Care Plan processes as assigned • Tracks daily eligibility of residents for continued Medicare benefits • Meets with therapists to report resident progress for those residents receiving direct therapy services under Part A or B Medicare services • Responsible for oversight and evaluation of consistency of documentation, care plans, physician orders, etc. to ensure accurate reimbursement • Ensures appropriate, accurate and timely completion of the physician certification/recertification form, SNF determination, and admission letter, SNF determination of continued stay, consent form (non-certified bed letter), beneficiary voluntary placement letter and Medicare secondary payer letter • Maintains back up documentation folders for Medicaid program • Monitors the facility Quality Measures Report and submits this report to appropriate personnel as directed Activity Aide • Monitors the appropriate MDS website for up to date changes in the instructional manual monthly and distributes changes in the instructional manual monthly and distributes changes to the interdisciplinary team as needed • Understands and reviews the facility’s Healthcare Clinical Policies and Procedures and Safety Guidelines • Reports any issues or problems that may arise to the Director of Nursing and/or Administrator • Complies with state, federal, and all other applicable health care and safety standards • Assists families and other visitors as needed • Attends/completes required in-services and other required meetings • Performs other duties as directed KNOWLEDGE, SKILLS and ABILITIES which may be representative but not all inclusive of those commonly associated with this position. • Language Ability - Reads and interprets documents.
Ability to write moderately complex reports and correspondence o Written Communication - Writes clearly and informatively; able to read and interpret written information o Verbal Communication - Talks to others to convey information effectively o English Language - Knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar • Math Ability - Knowledge of arithmetic and algebra, and their applications • Reasoning Ability - Ability to apply common sense understanding to carry out detailed written or oral instructions • Customer and Personal Service - Knowledge of principles for providing customer and personal services. This includes meeting quality standards for services and evaluation of customer satisfaction • Medicine - Knowledge of the information and techniques needed to assess and treat human injuries, diseases, and deformities. This includes symptoms, treatment alternatives, drug properties and interactions, and preventive health-care measures • Active Listening - Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times • Problem Sensitivity - The ability to tell when something is wrong or is likely to go wrong. It does not involve solving the problem, only recognizing there is a problem • Quality Management - Demonstrates accuracy and thoroughness • Organizational Support - Follows policies and procedures; completes tasks correctly and on time • Adaptability - Adapts to changes in the work environment; changes approach or method to best fit the situation; Able to deal with frequent change, delays, or unexpected events • Planning/Organizing - Prioritizes and plans work activities; advises for additional resources • Attendance/Punctuality - Ensures work responsibilities are covered when absent; arrives at meetings and appointments on time • Dependability - Completes tasks on time or notifies appropriate person with an alternate plan • Professionalism - Treats others with respect and consideration regardless of their status or position; accepts responsibility for own actions Safety: • Demonstrates ability to locate emergency equipment (i.e.
fire extinguisher) • Understands and can demonstrate knowledge of role in fire and disaster drills • Demonstrates ability to identify and respond appropriately to potential behavioral outbursts • Uses facility equipment safely Activity Aide • Recognizes, removes, and/or reports potential hazards • Follows established safety rules/accident prevention Infection Control: • Demonstrates proper hand washing techniques • Maintains proper food handling techniques and ensures glove usage, when necessary • Disposes of waste properly • Understands and maintains activity/kitchen sanitation procedures, when necessary Resident Care/Dignity: • Addresses residents in a respectful manner and knocks before entering residents’ rooms • Discusses confidential resident information in appropriate areas only Education & Experience: an equivalent combination of education, training and experience will be considered. • Graduate from an accredited nursing program; minimum of 2 years of previous long-term care experience; or an equivalent combination of education and experience • Must be licensed in the applicable state as a Licensed Practical Nurse (LPN) or Registered Nurse (RN); Registered Nurse (RN) preferred • Knowledge of RAI, Medicare and PPS processes required COMPUTER SKILLS/EQUIPMENT USED TO PERFORM THE JOB which may be representative but not all inclusive of those commonly associated with this position. • Desktop/Notebook computers • MS Office (Word, Excel, PowerPoint, etc.) • Various medical equipment Work Environment & Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. To perform this mission successfully, an individual should possess the physical ability to lift/move 50lbs, maintain a stationary position, move freely, operate equipment, ascend/descend freely, position self to reach equipment above or below normal standing height, and communicate with team members, residents, and residents’ family members.